Case Study: Physiotherapy Management of a 33-Year-Old Female with Multiple Sclerosis

-

Hospital Experience (2010–2012)

Presenting Complaint:

A 33-year-old female patient diagnosed with Multiple Sclerosis (MS) was referred to the physiotherapy department for long-term rehabilitation. The patient attended sessions three days a week, accompanied by her mother, who was also her primary caregiver. Her main challenges included wasting of muscles in both the foot and hand, leading to functional difficulties in walking, gripping, and general mobility.

History and Background:

The patient had been diagnosed with relapsing-remitting MS. At the time of physiotherapy referral, she was in a relatively stable phase but exhibited signs of muscular atrophy in the distal limbs, particularly the intrinsic muscles of the hands and the dorsiflexors of the feet. She reported early fatigue, difficulty in maintaining balance, and decreased ability to perform daily activities independently.

She relied heavily on her mother for mobility support and emotional reassurance. Given the complexity of MS, a multidisciplinary approach was crucial. I worked collaboratively with neurologists, occupational therapists, nursing staff, and a clinical psychologist to ensure a holistic care plan addressing her physical, emotional, and social needs.

Assessment:

During the initial sessions, I performed a comprehensive assessment including:

• Observation: Visible muscle wasting in the thenar and hypothenar regions of the hands; thinning of the calf and foot musculature

• Palpation: Reduced muscle bulk with no acute tenderness

• Muscle Tone: Hypotonia in distal extremities; mild spasticity was noted proximally in lower limbs

• Manual Muscle Testing (MMT):

- Hand grip: 2+/5

- Wrist extension: 3/5

- Ankle dorsiflexion: 2/5

- Hip and knee strength: 4/5

• Balance and Coordination: Difficulty with tandem walking, instability during transfers

• Gait: Unsteady with a short stride length and compensatory trunk movement

• Functional Limitations: Difficulty with writing, holding objects, foot clearance during walking, and fatigue with minimal exertion

Treatment Plan:

I initiated a phased rehabilitation program focused on maintaining function, improving strength, and enhancing her independence—coordinating regularly with other members of the hospital's neuro-rehabilitation team.

Therapy sessions were structured around:

1. Neuromuscular Re-education:

  • PNF techniques for upper and lower limbs to stimulate neuromuscular activation
  • Mirror therapy and proprioceptive input to enhance motor awareness

2. Strengthening Exercises:

  • Low-resistance, high-repetition exercises targeting wrist extensors, finger flexors, and ankle dorsiflexors
  • Seated leg and arm ergometry to improve endurance without overfatigue

3. Functional Task Training:

  • Reaching, gripping, and transfer practice using adaptive tools
  • Sit-to-stand drills and stair simulation to promote safe mobility

4. Balance and Gait Training:

  • Supported tandem walking, step-overs, and static balance exercises using parallel bars
  • Gait training with orthotic support for foot drop (where required)

5. Stretching and Range of Motion:

  • Passive and active ROM for joints at risk of stiffness
  • Spasticity control through sustained stretching, particularly in the lower limbs

6. Fatigue Management and Patient Education:

  • Scheduled rest periods between tasks
  • Education on pacing, energy conservation techniques, and adaptive strategies for daily activities

Psychosocial Support:

Throughout the sessions, I made sure to maintain open communication, offering encouragement and reassurance to both the patient and her mother. Her mother was involved in learning home exercises and transfer techniques to ensure continuity of care.

Outcome Measures:

• Grip Strength and Wrist Control: Improved, allowing better handling of utensils and personal items

• Walking Distance: Increased over time with reduced frequency of stumbles

• Fatigue Levels: Better managed through pacing and scheduling

• Emotional State: The patient became more engaged, responsive, and motivated during sessions

• Caregiver Confidence: Her mother expressed increased confidence in managing her needs at home

Prognosis:

While MS is a progressive neurological condition, the patient showed consistent improvement in her functionality, mobility, and quality of life. With the support of a coordinated hospital-based multidisciplinary team, she made meaningful gains that helped her remain as independent as possible in both physical and emotional aspects of life.

“This case taught me the profound value of compassionate care and collaboration. Working within a multidisciplinary hospital team allowed me to go beyond exercises—to truly advocate for this patient’s dignity, function, and future. My hands-on physiotherapy, combined with emotional encouragement and team coordination, made a difference in her journey with MS.”


Popular posts from this blog

Case Study: Stroke Rehabilitation

-
Multispecialty hospital, outpatient clinic, and freelance settings During my practice, I had the opportunity to work with several stroke patients across varied settings — including a multispecialty hospital and clinical OPD setup as well as a freelance physiotherapist providing home-based care. These experiences allowed me to develop a comprehensive and adaptable approach to post-stroke rehabilitation, tailored to each individual’s condition and environment. Presentation and Common Complaints: Most patients I managed during this period had suffered an ischemic or hemorrhagic cerebrovascular event affecting either the dominant or non-dominant hemisphere. They commonly presented with: • Hemiparesis or hemiplegia • Spasticity, especially in the upper limb flexors and lower limb extensors • Poor balance and postural control • Gait disturbances or inability to ambulate • Shoulder subluxation or pain on the hemiplegic side • Difficulty with activities of daily living (ADLs) • C...
Read more

Introduction to Women's Health Physiotherapy

-
Introduction Women’s Health Physiotherapy focuses on the prevention, assessment, and treatment of conditions that specifically affect women. These conditions can span the entire female lifespan, from adolescence to post-menopause. It covers a wide range of issues related to musculoskeletal, pelvic health, reproductive health, post-pregnancy care, and more. Women's health physiotherapists play an important role in improving the quality of life for women by addressing these physical, emotional, and psychological aspects.   1. Overview of Women's Health Physiotherapy What is Women’s Health Physiotherapy? • It is a specialized area of physiotherapy that focuses on treating physical and musculoskeletal issues, particularly those that are specific to women. • It also involves education and prevention techniques to address issues that women face due to physiological changes (such as pregnancy, menstruation, or menopause). Core Areas of Focus in Women's Health Physiotherapy: • ...
Read more

Physiotherapy Management of Low Back Pain

-
  Lower Back Pain and Pelvic Health: Understanding, Healing, and Empowering Women Lower back pain—something so many women experience but often feel like they have to “just live with.” Whether it’s a dull ache that won’t go away, sharp, stabbing sensations that come and go, or a tight, nagging discomfort that makes everyday tasks feel impossible, lower back pain is something you don’t have to accept as a part of life. It’s common, but it’s also something you can address and improve with the right tools and support. What’s even more important? Lower back pain and pelvic health are often deeply connected, and understanding this connection can unlock the path to relief. In this article, we’ll dive into what lower back pain is, how to identify it, why it’s often tied to pelvic health, and how you can start healing from home. We’ll also talk about when to reach out for professional help and how you can support other women in spreading awareness about the importance of pelvic and spinal...
Read more